Provider Demographics
NPI:1265719835
Name:LAMBERT, HALEY JO (LMT)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:JO
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 WESTOWN DR
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1070
Mailing Address - Country:US
Mailing Address - Phone:503-576-9347
Mailing Address - Fax:
Practice Address - Street 1:637 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1717
Practice Address - Country:US
Practice Address - Phone:503-576-9347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17167225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist